Son has TSH level of 0.59 (0.35-5.0), Free T4 level of 11.1 (9-24). He has been on anti-depressants for the last fourteen years.

[pingpong]

I have just noticed he appears to have a goiter (his collar size has recently increased by an inch to 17". He is always tired and always angry. I suffer from Graves and I showed these results to my endo, who said they were absolutely normal. There are thyroid problems going back through the family. Am I just being anxious or have I found a reason for his "depression"?

[naveed123]

Tsh level is normal.There may be another reason for depression.

[galathea in reply to naveed123]

Well he could have low thyroid hormones but not a high tsh. There is condition peculiar to some men were this can happen. See mcgill.ca/channels/news/new...

Best to get a full thyroid panel so you can check free t3, free t4 and rt3.

[PinkNinja]

TSH may be normal but t4 is very low in range. This could be indicative of central hypothyroidism where TSH appears normal but t4 is low or low normal.

Unfortunately, due to lack of education in thyroid disorders, it is going to be a fight to get thyroid hormone prescribed on the NHS.

The low-normal t4 could well be a contributing factor in your son's depression.

It would be wise to also get iron, ferritin, folate, b12, vitamin D and cortisol checked too. Low levels of these could be suppressing his TSH enough to cause symptoms so it is wise to make sure these are OK first.

I hope your son gets this sorted out soon so he can feel well again.

Carolyn x

[jimh111]

It would be useful to have an fT3 figure as well but I guess the idiot doctors don't do that. These figures are low, usually the TSH goes up if the fT4 is low. It could be 'central hypothyroidism', where the pituitary is beginning to fail. I'm assuming he has never taken thyroid hormones. Another more likely cause is 'non-thyroidal illness', this is where a concurrent or recent illness reduces thyroid hormone levels. Does he have some other illlness or infection? Also depression can cause this. In this case it becomes a vicious circle as antidepressants tend to be 'refractory' (i.e. don't work) when thyroid hormones are low. The answer then would be to simulataneously treat the hypothyroidism and depression. I get very irritable when hypo., I assume it is because the clearance of stress hormones is reduced when metabolism is slowed.

If you ask him to swallow and the possible goitre moves up and down it is more likely to be a goitre rather than ordinary fat around the neck.

I suggest your son tries to get an appointment with an endocrinologist, the presence of a goitre would be justification for a referral.

[galathea in reply to jimh111]

Tsh doesn't aways rise. mcgill.ca/channels/news/new...

[shaws Administrator]

If you decide to ask for a referral to an Endocrinologist email [e-mail] who has a list of sympathetic ones, one of whom may be near you. It could also be worth a journey.

[pingpong]

Thank you all for your replies. He has suffered "irritable bowel" for many years, along with weight gain, which has all been put down to taking anti-depressants. He gets breathless very easily and suffers from chest pains but all has been investigated and nothing found! Now to begin my fight!

[jimh111]

Irritable bowel can sometimes be caused by hypothyroidism, mine was. Forgot to say a number of antidepressants can cause hypothyroidism, need to check which ones he's on and whether he was taking them when having hypothyroid symptoms. It's a good idea to look into non-medication treatments for depression such as not sleeping too long (I know he's hypo), exercise and advice / counselling. The medications may be part of the problem, but absolutely do not stop them without expert advice.